Rachel Myr wrote: "She got flowers from her family and friends while in the hospital, and said she felt guilty accepting them, as she didn't deserve them, having not
produced a living child...."

Rachel is absolutely right that the mother deserved flowers. And it was good of her to tell her this. This story brought to mind a few general thoughts about grieving, mothers' expressions of feelings including guilt, and how we health care providers can help. There are several important principles in grief counseling, including the ten discussed by J. William Worden (2002) in the classic book, "Grief counseling and grief therapy: A handbook for the mental health practitioner":

1. help the bereaved to actualize the loss
2. help the bereaved to identify and experience feelings
3. help the bereaved to live without the deceased
4. help the bereaved to find meaning in the loss
5. facilitate "emotionally relocation" of the deceased
6. provide time to grieve
7. interpret "normal" behavior
8. allow for individual differences
9. examine defenses and coping styles
10. identify pathology and refer

Guilt is one of the feelings most problematic to bereaved people, though it is a common and normal part of grieving. When a mother loses a child and expresses guilt, we can help by letting her talk about her feelings (principle 2 above). If a mother is told that she shouldn't feel any particular emotion that she is feeling (guilt, anger, sadness, disappointment, failure, ...), she is likely to take home the message that there is something wrong with her for feeling what she is feeling. However, when a loss occurs during pregnancy (miscarriage, ectopic pregnancy, still birth) or shortly after birth, it is actually not uncommon for mothers to feel somehow responsible for that loss and to feel as though their bodies have failed. Mothers need to know that it is OK that they are feeling what they are feeling, that such feelings are a normal and common part of grieving (principle 7). In addition to the opportunity to experience emotional release, if a mother is given the chance to talk about feelings of responsibility, "reality checking" has a chance to occur. Maybe a mother believes that there is something she did or didn't do that caused the child's death. When we encourage her to talk about what she's feeling, we may find opportunities to provide or refer her to information that she does not currently have that could allay her feelings of guilt and responsibility. We also give her the opportunity to "speak the unspeakable" to someone who can bear to hear. After all, the mother is likely to be returning home to family and friends who are also grieving and who may not be able to listen to the painful feelings the mother needs so badly to express. Mental health care providers skilled in grief counseling can offer other ways of helping a mother cope with feelings of guilt and responsibility (including when there is actual culpability): for example, techniques of psychodrama can be used to express feelings of wrongdoing and to experience reconciliation and healing. We shouldn't hesitate to refer. For that matter, all hospitals should have staff trained in bereavement so that mothers can have support from the first moments of such a loss.

If anyone wants to learn more about grief counseling and grief therapy, I highly recommend Worden's book.

Worden, J. W. Grief counseling and grief therapy: A handbook for the mental health practitioner. New York: Springer Publishing Company, Inc. 2002.

Warmly,

Cynthia

Cynthia Good Mojab, MS clinical psychology, IBCLC, RLC
Ammawell
Website: http://home.comcast.net/~ammawell
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